Lymphoma

ZhongshanHospital,FudanUniversity

Zou

ShanhuaDefinition：Agroupofneoplasticdiseasesoflymphoidtissues

Classification：

Hodgkin′sDisease,HD(Hodgkin′sLymphoma)

NonHodgkin′sLymphoma,NHL)GeneralconsiderationsClinicalFeatures：Painless,progressivelymphadenectasis

Fever,wasting,nightseat；cachexia

SplenohepatomegaliaEpidemiology：

Incidence：

urban/rural;male/female;age

HD8～11％；NHL90%GeneralConsiderationsVirulogy:EBvirus→Burkittlymphoma、HD

HTLV-Ⅰ→ATLHTLV-Ⅱ→Mycosisfungoides

EtiologyandPathogenesis

ImmuneStatesofHost：

Immunedeficiency/immunesuppressionMechanism：Antigenicstimulction→

lymphadenosis(modulation↓)

→infiniteproliferation→lymphomaEtiologyandPathogenesisHD：Reed-Sternberg(R-S)Cell

RyeClassification，1966LymphocytepredominanceNodularsclerosisMixedcellularity

Lymphocytedepletion

ClassificationofLymphomaNHL：IWF，1982REAL，1994WHO，2000ClassificationofLymphomaWorkingformulationLow-gradelymphomaA.smalllymphocytic,consistentwithchroniclymphocyticleukemia

plasmacytoid

B.follicular,predominantlysmallcleavedcelldiffuseareassclerosisC.

follicular,mixedsmallcleavedandlargecelldiffuseareas

sclerosisWorkingformulationIntermediate-gradlymphomaD.

follicular,predominantlylargecelldiffuseareassclerosisE.diffuse,smallcleavedcellsclerosisF.

diffuse,mixedsmallandlargecellsclerosis

epithelioidcellcomponentG.

diffuse,largecellcleavedcell

noncleavedcellsclerosis

WorkingformulationHigh-gradelymphomaH.mmunoblastic,largecell

plasmacytoidclearcellpolymorphous

epithelioidcellcomponentI.lymphoblastic,convolutedornonconvolutedcellJ.smallnoncleavedcell,Burkitt'sornon-Burkitt's

WorkingformulationMiscellaneouscompositemycosisfungoides

histiocytic

extramedullary

plasmacytomaunclassifiableotherREALClassification

B-cellneoplasmsI.PrecursorB-cellneoplasm:precursorB-lymphoblasticleukemia/lymphomaII.PeripheralB-cell

neoplasms

A.B-cellchroniclymphocyticleukemia/prolymphocyticleukemia/smalllymphocyticlymphoma

B.Lymphoplasmacytoidlymphoma/immunocytoma

C.Mantlecelllymphoma

D.Folliclecentercelllymphoma,follicular1.Provisionalcytologicgrades:Ismallcell,IImixedsmallandlargecell,IIIlargecell2.Provisionalsubtype:diffuse,predominantlysmallcelltype

REALClassificationE.MarginalzoneB-celllymphoma1.Extranodal(MALT-type+/-monocytoidBcells)2.Provisionalsubtype:nodal(+/-monocytoidBcells)F.Provisionalentity:splenic

marginalzonelymphoma

(+/-villouslymphocytes)G.HairycellleukemiaH.Plasmacytoma/plasmacellmyeloma

I.DiffuselargeB-celllymphoma1.Subtype:primarymediastinal(thymic)B-celllymphomaJ.Burkitt’slymphomaK.Provisionalentity:high-gradeB-celllymphoma,Burkitt-like

REALClassificationT-cellandputativeNK-cellneoplasmsI.PrecursorT-cellneoplasm:precursorT-lymphoblasticlymphoma/leukemiaII.PeripheralT-cellandNK-cellneoplasms

A.T-cellchroniclymphocyticleukemia/

prolymphocyticleukemiaB.Largegranularlymphocyteleukemia1.T-celltype2.NK-celltypeC.Mycosisfungoides/Sezary’syndrome

REALClassificationD.PeripheralT-celllymphomas,unspecified1.Provisionalcytologiccategories:medium-sizedcell,mixedmediumandlargecell,largecell,lymphoepithelioidcell2.Provisionalsubtype:hepatosplenicgamma/deltaT-celllymphoma3.Provisionalsubtype:subcutaneouspanniculiticT-celllymphomaE.AngioimmunoblasticTcelllymphomaF.AngiocentriclymphomaREALClassificationG.IntestinalT-celllymphoma(+/-enteropathyassociated)H.AdultT-celllymphoma/leukemiaI.Anaplasticlargecelllymphoma1.CD30+-celltype2.T-celltype3.Null-celltypesJ.Provisionalentity:anaplasticlargecelllymphoma,Hodgkin's-like

ClinicalFeatures

HDNHL

Age

Youngpeople

Moreofteninmiddle-agedpeople

Superficiallymphnodes

60～80％

50%

(firstobservedastumefactionofcervicalorsupraclavicularlymphnodes)

Mediastinallymphnodes

50%

20%

Retroperitoneallymphnodes

Seldominvaded

Ofteninvaded

Fever

Oftenoccurred

Seldominearlyperiod

Itchofskin

Oftenoccurredinsomeyoungfemalepatients

Seldomoccurred

Specificskinlesion

Seldomoccurred

OftenoccurredExtranodalsites

Seldomoccurred

Oftenoccurred

(Waldeyer’sring,gastrointestinaltract,bonemarrow,CNS,liver,lung,pleura,bone,skin,kidney)

Wayofdissemination

Metastasistonearbylymphnodes

Inajumpingway

Bonemarrowinvolvement

SeldomoccurredOftenaccompaniedwithleukemia

Progress

Slower

Faster

Prognosis

Better

Worse

LabandOtherFindingsPeripheralBloodandBoneMarrow

HD：Eosinophilia；R－Scell

NHL：Lymphocytosis;ComplicatedleukemiaLDH，β2-MG,Coombstest，globulinImmunophenotype

CytogeneticandMolecularStudiesRadiologicstudiesChestX-rayCT,MRIRadioactivenuclideB-ultrasoundBiopsyDiagnosis

Painless,progressive

lymphadenectasis

→Biopsy

SkinLesion→Biopsy

BoneMarrowAspirationandBiopsyBiopsyofOtherSitesDiagnosisandDifferentialDiagnosisStagingoflymphomaStageDefinitionⅠInvolvementofasinglelymphnoderegionorofasingleextranodalorganorsite(ⅠE)ⅡInvolvementoftwoormorenoderegionsonthesamesideofthediaphragm,orlocalizedinvolvementofan

extranodalsiteororgan(ⅡE)andoneormorelymphnoderegionsonthesamesideofthediaphragmⅢInvolvementoflymphnoderegionsonbothsidesofthediaphragmwhichmayalsobeaccompaniedbylocalizedinvolvementofanextranodalorgansorsite(ⅢE)orspleen(Ⅲs)orboth(ⅢsE)ⅣDiffuseordisseminatedinvolvementofoneormoredistant

extranodalorganswithorwithoutassociatedlymphnodeinvolvementBsymptomsFever>38℃,nightsweats,and/orweightloss>10%ofbodyinthe6monthsDifferentialDiagnosis

Lymphadenectasis：

Chroniclymphadenitis

Tuberculouslymphadenitis

Tumournodemetastases

Fever：Septicaemia,tuberculosis,rheumaticdisease

ExtranodalLymphoma:OthermalignanttumerDiagnosisandDifferentialDiagnosisRadiationTherapy

60Co,acceleratorlinear

Dosage:30～40GY，3～4W

Methods：Localfieldirradiation(LFI)

MantleorinvertedYirradiationTotalnodalirradiation(TNI)TreatmentIndication：HDⅠA,ⅡA：Extendedfieldirradiation(EFI)ⅠB,ⅡB,ⅢA：TNIand/orcombinationchemotherapyⅢBⅣ：Combinationchemotherapymainly(oraddlocalirradiation)NHLLow-GradeⅠ、Ⅱ,Mid-GradeⅠ：EFIorlocalirradia